How Iraq’s Once Effective Healthcare System Was Sold Down the Nation’s Two Rivers

Fri 18th Apr 2008

During the 1970s, a centralised model of healthcare was established in Iraq. Such a system, based upon a Western model enabled, free healthcare to be accessed by the entire Iraqi population. As such, in the 1970s and 80s, the Iraqi health system was considered to be one of the best in the Middle East and was regarded as functioning at near first world standards. The country’s immense oil reserves were used to pay for large amounts of drugs and medical equipment, which were imported from abroad. A 2003 report from UNICEF and the World Health Organisation (WHO) revealed that before 1990, 97% of urban dwellers and 71% of the rural population had access to primary healthcare in Iraq.

However, the fate of healthcare in Iraq began to change in 1990 with the outbreak of the first Gulf war and the UN Security Council’s decision to impose economic sanctions on the country. Within a period of 6 weeks, 88,000 tonnes of bombs, the equivalent of 7 Hiroshima explosions, had been dropped on Iraq. Cholera, typhoid and other water-borne diseases became rife as water and sewage treatment plants, which had been damaged, were no longer functioning at their optimal capacity. Deaths from diarrhea increased by five-fold. The economic sanctions that followed the war led to the impoverishment of Iraq and produced a downward spiral in the nation’s health. Between the years 1990 and 1993, Iraq’s GNP dropped by around 75%. Chronic shortages of food and medicine became the norm. A UNICEF report estimated that by 1997, one million children below 5 years of age were malnourished.

Furthermore, as part of the package of sanctions imposed upon the country, an ‘intellectual boycott’ led to Iraqi doctors being cut off from medical and scientific developments happening around the world.

The mortality rate amongst children under the age of 5 rose from 56 per 1000 live births (during the period 1984-1989) to 131 per 1000 (during the years 1994-1999). This was described by Madeleine Albright, then US Secretary of State, as "a price worth paying".

A large increase in the incidence of childhood cancers, widely believed to have been the consequence of Depleted Uranium shells being used by coalition forces, became noticeable in the years following the first Gulf war. Dr Muhammad Hilal, former chief paediatrician of a hospital in Baghdad, has commented that remission rates for childhood cancer plummeted from 70% in 1990 to around 6 or 7% by the end of the decade. In all, the UN has estimated that over a million extra deaths occurred in Iraq as a consequence of the sanctions.

The concept of bringing a country to its knees without having to fire a single shot was eloquently enunciated in 1919 by President Woodrow Wilson, who described sanctions as being a ‘‘peaceful, quiet and lethal remedy [which] doesn’t take a single life outside of the country exposed to the boycott but instead subjects that country to a pressure that, in my view, no modern country can withstand.’’

However, the first Gulf war was perhaps only to serve as a practice run for a future conflict and the sanctions were only a taster of what was in store for Iraq’s populace. The already crippled healthcare system was to take an even greater battering with the onset of the illegal invasion in 2003. In the initial stages of the war, 7% of the nation’s hospitals sustained damage and 12% experienced looting. Many government buildings were also ruined. The steady exodus of Iraqi health professionals which had been taking place throughout the 1990, now ratcheted up from 2nd to 5th gear.

Several decisions made either before the conflict began, or during its early stages, hammered more nails into the coffin of Iraq’s health infrastructure. As the invasion took place without a UN mandate, no utilisation of a number of individuals who possessed knowledge of post conflict health planning was made in the days following the invasion. In Iraq itself, numerous health experts were dismissed from their jobs as part of the US determined process of ‘de-Baathification.’ Contrary to the requirements of the Geneva Convention, hospitals received inadequate protection by the occupying forces. In 2004, there were even reports of humanitarian convoys being denied access to the besieged city of Fallujia. The larger reconstruction contracts were bequeathed to private companies, rather than being placed in the hands of the WHO or UNICEF.

To add insult to injury, Iraqi communities were largely excluded from decision-making and planning in matters of healthcare provision. Of the $18.4 billion Iraq Relief and Reconstruction Fund that the US gave to the CPA, a mere 4% was set aside for health, even though Paul Bremer, who in 2003 had been appointed Director of Reconstruction and Humanitarian Assistance in Iraq, stated that he was aware this sum of money would be insufficient. A rapid turnover of health ministers since 2003 has further intensified the instability. Meanwhile, the training of health professionals has suffered as medical schools are struggling to remain open. A 2008 report, released by the British NGO Medact, indicated that ‘5 years after the invasion, Iraq [still] has no comprehensive health policy or funding strategy.’

One of the manifestations of the decimation of Iraq’s healthcare infrastructure has been an increase in the levels of drug and alcohol abuse. Since 2003, three-quarters of doctors, nurses and pharmacists have ceased working and half of these have fled the country. The Medact report estimated that only 9,000 doctors and 15,000 nurses now remain in Iraq to serve a population of approximately 25 million, while Save The Children has stated that the death rates amongst Iraqi children under 5 are now approaching those of Sub-Saharan Africa.

One area of healthcare that has received little attention since 2003 is that of mental health services, currently much needed in Iraq. The effects of the war upon the mental health of the civilian population are immeasurable and their long-lasting repercussions are as yet unknown. Adult mental health services are limited, while children’s mental health services are non-existent. Aside from the million deaths that can be attributed to the invasion, the toll that the war has taken on the physical and mental health of the Iraq non-combatants is perhaps particularly heavy among the 2 million internally displaced Iraqis. Those lucky enough to have received refuge in Syria, Jordan or Egypt still face the struggle of finding work and suitable accommodation.

These Arab countries have put much of the rest of the world to shame through the kindness they have exhibited towards their neighbours. Of course, little has been done in the way of helping these countries shoulder one of the burdens brought about by the war. The UK Iraq Commission, an independent cross-party commission made clear recommendations before the publication of their 2007 report that Syria should receive support. Recommendations were also made by Medact and by others, that Syria and its neighbours should be part of any political solution made in the region. Syria’s infrastructure, in particular, has struggled to cope with an influx of 1.5 million refugees. As the cost of food and fuel has also risen sharply, there is evidence that some sections of the Syrian population have started to harbour grudges against the refugees. The Syrian government has refused to take in an additional number of refugees, although it has stated that it will not expel anyone already there.

A plan recently proposed by the Iraqi government to decrease food rations in Iraq from June 2008 will ensure that malnutrition and hunger become even more widespread. They have stated that the decision is ‘in line with their obligations to the World Bank’. Whatever these obligations are, if the proposal does go ahead, the ‘green-zone government’ may just manage to outdo the brutality of Saddam who, even at the height of sanctions, introduced a rationing system to combat the effects of the sanctions upon Iraq’s population. The scheme was subsequently described by the UN as ‘the world’s largest and most effective relief effort.’

The question of why coalition forces cannot simply subsidise these rations is one that needs an answer. This would provide the perfect opportunity to give something back to the people of Iraq. The US alone spends about $720 million a day on the war. Certainly subsidised food would cost only a fraction of this price, bring to mind the lyrics of US folk singer Pete Seeger’s Vietnam-era song ‘Bring em home’, which includes the line: ‘…the world’s got hunger and ignorance… you can’t fight that with guns and bombs.’